Table Of ContentEarly-Age Orthodontic Treatment
2
EARLY-AGE
ORTHODONTIC
TREATMENT
Aliakbar Bahreman, DDS, MS
Clinical Professor
Orthodontic and Pediatric Dentistry Programs
Eastman Institute for Oral Health
University of Rochester
Rochester, New York
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Library of Congress Cataloging-in-Publication Data
Bahreman, Aliakbar.
Early-age orthodontic treatment / Aliakbar Bahreman.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-86715-566-2
I. Title.
[DNLM: 1. Malocclusion--therapy. 2. Adolescent. 3. Child. 4. Orthodontics, Corrective--methods. WU 440]
617.6’45--dc23
2013001198
© 2013 Quintessence Publishing Co, Inc
Quintessence Publishing Co, Inc
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Editor: Leah Huffman
Design: Ted Pereda
Production: Angelina Sanchez
Printed in China
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Contents
Foreword by J. Daniel Subtelny
Preface and Acknowledgments
Introduction
Clinical and Biologic Principles of Early-Age
Part I
Orthodontic Treatment
1 Rationale for Early-Age Orthodontic Treatment
2 Development of the Dentition and Dental Occlusion
3 Examination, Early Detection, and Treatment Planning
Early-Age Orthodontic Treatment of Nonskeletal
Part II
Problems
4 Space Management in the Transitional Dentition
5 Management of Incisor Crowding
6 Management of Deleterious Oral Habits
7 Orthodontic Management of Hypodontia
8 Orthodontic Management of Supernumerary Teeth
Diagnosis and Management of Abnormal Frenum
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Attachments
10 Early Detection and Treatment of Eruption Problems
Early-Age Orthodontic Treatment of Dentoskeletal
Part III
Problems
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Management of Sagittal Problems (Class II and Class III
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Malocclusions)
Management of Transverse Problems (Posterior
12
Crossbites)
Management of Vertical Problems (Open Bites and Deep
13
Bites)
Bonus Cases
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Foreword
This book is a compendium of significant and pertinent information related to early-
age orthodontic treatment, a subject that seems to have evolved into one of
considerable controversy, with as many orthodontists expressing a negative reaction
as a positive reaction to its benefits. Dr Bahreman is a believer in early-age
orthodontic treatment, and he expresses some cogent arguments founded in years of
experience in practice and teaching to back up his beliefs. In developing his treatise,
Dr Bahreman outlines the development of the occlusion and/or malocclusion from
the embryonic stages, when the foundation of the jaws and thereby the position of the
dentition is first established.
Early-age orthodontics is not about the time it takes to orthodontically treat a
problem; it is a story of growth, of variation in anatomy, and of muscle function and
influences, a realization that it is the jaws that contain the teeth and that where the
jaws go, the teeth will have to go, and both undergo varying influences as well as
grow in varying directions. Early-age orthodontics necessitates recognition of this
process and aims to alter and redirect it whenever feasible and possible. Dr
Bahreman has undertaken a monumental effort in directing efforts along this path. An
extensive exploration of the literature is an added bonus, as the mechanical
approaches are based on this literature. In fact, the extensive review of the literature
and its application to diagnosis and varying forms of therapy are worth a veritable
fortune.
You may or may not agree with the basic premises, but you will have access to
important information that will widen your scope of vision and thereby widen your
treatment horizons. To my mind, an ounce of prevention, if possible, is worth a
pound of cure. The reality of prevention can exist at the earliest stages of
development.
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J. Daniel Subtelny,
DDS, MS, DDSc(Hon)
Professor Emeritus
Interim Chair and Director of Orthodontic Program
Eastman Institute for Oral Health
University of Rochester
Rochester, New York
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Preface
After obtaining a master’s degree in orthodontics in 1967, I began my career at a
newly founded dental school in Tehran. My responsibilities included teaching and
administrative duties at the university and maintenance of a very busy private
practice. In addition, I established both the orthodontic and pediatric dentistry
departments at the university.
Many patients were being referred to the orthodontic department, and there were
no qualified faculty members to help me provide care. To rectify the situation, I
designed an advanced level, comprehensive curriculum in orthodontics for
undergraduate students, including classroom instruction, laboratory research, and
clinical demonstrations. Once the students completed the course, they could work in
the clinic, thus temporarily solving the issue of the heavy patient load in the
orthodontic clinic. With additional staff now available, I could select patients,
mostly children in the primary or mixed dentition, for some interceptive treatment.
Despite my difficulties in performing all of the aforementioned duties, this
situation had a fortunate outcome. It helped me to understand and discover the
advantages of early-age orthodontic treatment, which was not common in those
years. During my more than 40 years of practice and teaching, especially in early
orthodontic treatment, I have accumulated a considerable amount of educational data
for teaching purposes. I would like to share this experience and information with
readers.
The public’s growing awareness of and desire for dental services, especially at
an early age, have encouraged our profession to treat children earlier. Despite the
recommendation by the American Association of Orthodontists that orthodontic
screening begin by the time a child is 7 years old, many orthodontists still do not
treat children prior to the complete eruption of the permanent teeth. I believe that this
inconsistency is due to the educational background of orthodontists as well as a lack
of familiarity with recent technical advancements and the various treatment options
that are available for young patients.
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The therapeutic devices available for this endeavor are not complex, but deciding
which ones to use and when to employ them are important steps. As we make these
decisions, we should also remember not to treat the symptom but rather to treat the
cause. My goal is to present the basic information necessary to understand the
problems, to differentiate among various conditions, and to review different
treatment options. Case reports are examined to facilitate clinical application of the
theory in a rational way.
To understand the morphogenesis of nonskeletal and skeletal occlusal problems,
to detect problems early, and to intervene properly, we must look at all areas of
occlusal development, including prenatal, neonatal, and postnatal changes of the
dentoskeletal system, and explore all genetic and environmental factors that can
affect occlusion at different stages of development. In other words, we must have a
profound understanding of the fundamental basis and morphogenesis of each problem
and then apply this knowledge to clinical practice. Thus, the goals of this book are:
• To provide a comprehensive overview of all areas of dental development, from
tooth formation to permanent occlusion, to refresh the reader’s memory of the
fundamentals necessary for diagnosis and treatment planning.
• To emphasize all the important points of the developmental stages that must be
recognized during examination of the patient to facilitate differential diagnosis.
Each tooth can become anomalous in a number of ways and to different degrees.
Occlusion and maxillomandibular relationships can vary in the sagittal,
transverse, and vertical directions.
• To discuss the application of basic knowledge to practice by presenting several
cases with different problems and different treatment options.
• To demonstrate the benefits of early-age orthodontic treatment, achieved by
intervention in developing malocclusion and guidance of eruption.
Materials are presented in three parts: In Part I, “Clinical and Biologic Principles
of Early-Age Orthodontic Treatment,” three chapters introduce and explain the
concept of early-age treatment, describe its necessity and advantages, and discuss
the controversies surrounding this topic; discuss the basic foundation of occlusal
development, empowering the practitioner to detect anomalies and intervene as
necessary; and illustrate the procedures, tools, and techniques available for
diagnosis, emphasizing differential diagnosis and treatment planning for early-age
treatment.
Part II, “Early-Age Orthodontic Treatment of Nonskeletal Problems,” consists of
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